Here we go again … The metabolic syndrome revisited!

Abstract

Whilst all innovations and new ideas will have their passionate proponents, one of the sine qua non of the medical world is that it will also have its opponents. The concept of the metabolic syndrome was no exception and went through its debates and controversies. With the harmonization between the AHA/NHLBI and the IDF definitions for the diagnosis of the metabolic syndrome, one would have hoped that that we would now take a step forward and thrash out a consensus on the metabolic syndrome between the opponents and the proponents so that we could leave this controversy behind us. But a WHO Expert Consultation Group recently came out with a report which basically reiterated the old arguments, though in a more nuanced manner, which had been used by those opposing the concept of the metabolic syndrome from its initial stages. The report points out that, despite an exponential increase in the number of research papers on the subject, no single unifying pathophysiological mechanism has been agreed, and the equivalence of the risk factors and their cutoff points across different populations has not been established. The criteria used to diagnose the metabolic syndrome have major limitations including: the dichotomisation of risk factors; the attribution of relative as opposed to absolute risk; the differing predictive value of risk factor combinations; the inclusion of individuals with established diabetes and heart disease; and the omission of important risk factors for predicting diabetes and CVD. A formal diagnosis of the metabolic syndrome is rarely made in routine clinical practice, and the concept has not been widely adopted in national guidelines for the prediction of CVD or diabetes. The end recommendation was that whilst, it may be considered useful as an educational concept, it should be considered a premorbid condition with limited practical utility as a diagnostic or management tool. Many of these questions have been answered in the past. The need of the hour is not too guard one's turf or come out with controversial statements, which frankly are no more than hindrances at least in this instance, but accept that we are facing a major problem as far as the ravages associated with T2DM and ASCVD are concerned and that we have to join hands and take immediate and definitive steps to prevent and optimally manage the risk factors associated with these pandemics. This can only be done by empowering both patients, and especially the primary care givers, who in many instances are the first, and often, the only medical personnel who a person has access to. Highly academic guidelines dictated by a few people are not the way forward. We need to be inclusive, take ground realities into consideration to help various regions and countries evolve the most optimal way forward. It would be better for the WHO consultation group to accept that, with the metabolic syndrome, we have a tool in our hands which can make both the treating physicians as well as the people aware of the need for early diagnosis and a comprehensive treatment of any, and all, risk factors for T2DM and ASCVD, and which would be “available, accessible and affordable” to most, if not all, people, rather than discard this as being “a premorbid condition of no clinical utility but just an exercise in futility”.